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Friday, November 05, 2010

AAN Position: Concussed Athletes Should Be Removed from Play Immediately and Assessed Before Returning

By Kierstin Wesolowski

Any athlete who appears to have sustained a concussion should immediately be removed from play and be evaluated by a doctor who has training in sports concussion before returning to sports.

That’s the overall recommendation made in the American Academy of Neurology’s (AAN) new position statement on sports concussion management, released Nov. 1. The position statement also recommends that athletes abstain from sports until the athlete has been evaluated by a doctor who has training in sports concussion and until the symptoms of a concussion have alleviated. It also recommends that a certified trainer is present at every sporting event and that educational efforts on concussions are emphasized to improve coaches’, players’, and parents’ understanding of the dangerous risks associated with concussion.

The release of the position statement, which applies to athletes of all ages and skill levels, coincides with the public’s recent increased awareness of the adverse effects associated with concussions, per the public acknowledgment of these risks by the National Football League in recent months. (See “NFL Amplifies Penalties for Flagrant Hits to the Head” at neurologynow.com).

The AAN decided to release the practice position statement now, based on the timeliness of when we will be able to produce our new practice parameter document on concussion management in sports, said Jeffrey Kutcher, MD, director of Michigan Neurosport at the University of Michigan and chair of the AAN Sports Neurology Section. The updated practice guideline is slated for release in 2012.

“We wanted to release a position statement that at least addressed the concept that the 1997 document shouldn’t be followed to the letter, and that people should be managing concussions individually and not as described in that document,” he added.

When asked whether it is financially feasible for every school to employ a certified trainer at every sporting event, Dr. Kutcher acknowledged that the position statement represents the AAN’s optimal goals, and that some schools may lack the resources to do so. In those particular instances, Dr. Kutcher hopes school officials take into careful consideration whether it’s a priority to have contact sports at the school.

“If it is, then they should seek out ways to further educate those that are around during the event, such as the coaches, parents, athletes, the school nurse, or whoever else might be in that environment,” he said. “At the very least, there’s a huge gap in education that needs to be filled in.

“Our number one priority is the health of our athletes, and that means athletes at all levels,” said Dr. Kutcher. “And specifically in regards to what we do [at the AAN], it’s improving the quality of their neurological care.”

The AAN's position statement on sports concussion is available in its entirety here http://bit.ly/cfKMXa. For more on sports' neurologists' and athletic organizations' reactions to the position statement, read a future issue of Neurology Now in print and online at neurologynow.com.

To a large degree health professionals do a poor job of screening for a prior history of traumatic brain injury. Simply asking "Have you ever sustained a brain injury?" usually is not enough. Plus, the nomenclature is confusing and often misunderstood, as the terms concussion, head injury, mild brain injury, brain injury, traumatic brain injury, and neurological insult are used interchangeably and don’t tell the whole story. Asking about previous falls, motor vehicle accidents, and moments of feeling “dazed and confused” can and often do lead clinicians to a better understanding of people’s problems that resulted from a history of TBI/MTBI.
Until the medical profession as a whole develops more adequate screening that asks about injuries that occurred in infancy, childhood, adolescence, and young adulthood, TBI will continue to be The Silent Epidemic affecting the miserable minority with The Unseen Injury.